Price transparency is playing a more and more critical role in health care. As Costs of Care Executive Director Neel Shah, M.D. has stated, “We make purchasing decisions for every other commodity based on transparent price and quality information (think Yelp, Travelocity). Why not healthcare, too?”
There is a widely-held view that publishing price information could both rein in the enormous range of costs people pay and lower the level of prices in general. This kind of price transparency potentially may allow patients to comparison shop for health care as they would a car, house or television, forcing higher priced providers to lower their prices to stay competitive.
The Patient Protection and Affordable Care Act (ACA) has enabled an additional 15 million individuals to obtain health care insurance. With many of the newly insured (and others) choosing one of the less expensive “bronze” or “silver” plans, which typically cover 60 to...
Are we heading toward a health care system in which medical care comes with a money-back guarantee? That would seem to be the ultimate stage of accountability. We do not see anesthesia, pain medicine or any other practices offering to refund payments if patients are not satisfied on the horizon. We are aware of only one instance of a money-back offer in health care: Janssen Pharmaceuticals recently entered into an arrangement with the English National Health Service under which Janssen UK will refund the cost of its hepatitis C drug Olysio for patients who do not successfully clear the virus after 12 weeks. Janssen will also offer free access to pre-treatment blood tests to determine which patients are likely to benefit from treatment. (McKee S. Janssen offers NHS to pay for Olysio failures. PharmaTimes Digital, January 15, 2015.)
Warranties are starting to take hold, however. In the commercial arena, warranties obligate...
If anesthesiologists and pain specialists are like other physicians, at least as far as this question goes, online rating web sites like HealthGrades and Vitals do not provide much useful information on provider quality.
A recent study funded by the American Board of Internal Medicine (ABIM) found that there is little to no association between physicians’ online ratings and how well they score on performance measures or on patient-experience surveys conducted by their own practices. Researchers led by Bradley M. Gray, PhD looked at 1,299 physicians who completed an ABIM Practice Improvement Module® (PIM) in diabetes or hypertension between July 2011 and November 2012. These modules guide physicians through a review of patient data and support quality improvement work and reporting in their practices. PIM patient survey responses and chart abstractions were compared against the ratings physicians received on eight leading, publicly available and free rating websites. Sites were selected from...
Does your practice have any Medicare appeals pending? If you have appealed a decision within the last several years, be prepared to wait a long time for a ruling. The backlog of provider appeals has grown so that the system is heavily overloaded, causing at least a two-year delay for appeals to be heard at the Administrative Law Judge (ALJ) level. One of the key contributing factors is the RAC program. The number of appeal from RAC determinations has grown exponentially since the program began in 2011. In 2013 alone, there was a 506 percent increase in appealed RA program claims over fiscal year 2012, versus a 77 percent increase in appealed claims not related to the RA program during that same period of time.
The RACs are paid a hefty commission of approximately 9.0-12.5 percent for denied claims. They may keep this bounty unless the claim denial is later overturned...
As we write this Alert on Christmas Day, we are thinking about the tumultuous year gone by. So much is changing so fast that it’s hard to stop long enough to catch our breath. Below are some of the developments through 2014 that are going to shape our future, immediate and long-term. Inclusion of a particular change or trend does not mean that it was necessarily among the most important; nor does omission mean that a given development was less momentous. There are far too many issues for an exhaustive list.
Anesthesia
The Perioperative Surgical Home (PSH). The PSH model of care—a patient-centered, physician-led system of coordinated care striving for better health, better health care and reduced costs of care—gained traction throughout 2014. In April, ASA announced the selection of Premier, Inc. to develop a first-of-its-kind learning collaborative for the PSH. The first learning collaborative cohort consists of 44 provider organizations currently...